1295796845 NPI number — KEVIN PRANIKOFF MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295796845 NPI number — KEVIN PRANIKOFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRANIKOFF
Provider First Name:
KEVIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295796845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
462 GRIDER STREET
Provider Second Line Business Mailing Address:
SUITE 119
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-898-5008
Provider Business Mailing Address Fax Number:
716-898-4186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462 GRIDER STREET
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-898-5008
Provider Business Practice Location Address Fax Number:
716-898-4186
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  124932 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00010140903 . This is a "BUFFALO COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00010140903 . This is a "UNIVERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "CB COMMUNITY CARE FAMILY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900822 . This is a "IHA ENCOMPASS 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0010640 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "COMMUNITY BLUE ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00010140903 . This is a "UNIVERA CHOICE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00631434 . This is a "GOLD CHOICE MCD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "COMMUNITY BLUE SENIOR BLU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00631434 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1900822 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000507827003 . This is a "BLUE CROSS BLUE SHIELD WN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900822 . This is a "IHA MEDISOURCE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com